Histol Histopathol (2000) 15: 131 -1 42
http://www.ehu.es/histol-histopathol
Invited Re vie W
Histology and Histo pathology Cellular and Molecular Biology
The female prostate and prostate-specific antigen.
lmmunohistochemical localization, implications of this prostate
marker in women and reasons for using the term "prostate" in the
human female M. Zavia&iEl and R.J. Ablin2
'Department of Pathology, Comenius University School of
Medicine, Bratislava, Slovakia and 21nnapharma. Inc., Suffern, NY,
USA
Summary. Prostate-specific antigen (PSA) is currently the most
frequently used marker for the identification of normal and
pathologically altered prostatic tissue in the male and female.
Immunohistochemically PSA is expressed in the highly specialized
apically-superficial layer of female and male secretory cells of
the prostate gland, as well as in uroepithelial cells at other
sites of the urogenital tract of both sexes. Unique active moieties
of cells of the female and the male prostate gland and in other
parts of the urogenital tract are indicative of secretory and
protective function of specialized prostatic and uroepithelial
cells with strong immunological properties given by the presence of
PSA. In clinical practice, PSA is a valuable marker for the
diagnosis and monitoring of diseases of the male and the female
prostate, especially carcinoma. In the female, similarly as in the
male, the prostate (Skene's gland) is the principal source of PSA.
The value of PSA in women increases in the pathological female
prostate, e.g., carcinoma. Nevertheless, the total amount of PSA in
the female is the sum of normal or pathological female prostate and
non-prostatic female tissues production, e.g., of diseased female
breast tissue. The expression of an antigen specific for the male
prostate, i.e., PSA in female Skene's glands and ducts, and
structural and functional parameters and diseases similar to that
of the male prostate, have provided convincing evidence of the
existence of a prostate in women and definitive preference of the
term "prostate" over that of Skene's glands and ducts. The use of
the term Skene's glands incorrectly implies that some other
structure rather than prostate is involved, promoting the vestigial
position of this female organ.
Offprint requests to: Professor Milan ZaviaEE, MD, DSc.,
Department of Pathology, Cornenius University School of Medicine,
Sasinkova 4, 81 1 08 Bratislava, Slovakia. Fax: 00421
-7-59357592
Key words: Prostate-specific antigen (PSA), Female prostate,
Skene's gland, Male prostate, Immunohisto- chemistry, Serology,
Female PSA implications, Male PSA implications, Terminology
Introduction
Reinier de Graaf (1641-1673), a Dutch physiologist and
histologist, was the first to describe the female prostate and to
assign it this term (de Graaf, 1672). One year before his death, de
Graaf (1672) described in his work "De mulierum organis generationi
inservientibus . . . ." exactly, and perfectly for his time, the
structure of the female prostate as being formed by glands and
ducts located around the female urethra. De Graaf was also the
first who attempted to formulate the function of the female
prostate on writing: "The function of the prostate (corpus
glandulosum) is to generate a pituitoserous juice which makes women
more libidinous with its pungency and saltiness and lubricates
their sexual parts in agreeable fashion during coitus" (Jocelyn and
Setchell, 1972). Although de Graaf's notion of homology of the
female paraurethral glands and ducts as the female prostate with
the male prostate was essentially but an intuitive idea, he is
doubtless the discoverer of the female prostate and should be
accepted and acknowledged as such.
Some 200 years after de Graaf, the American gynecologist,
Alexander J.C. Skene (1838-1900), redescribed the female prostate
as being comprised of two main paraurethral ducts that bear his
name - Skene's glands - opening on both sides of the urethral
orifice (Skene, 1880). Following Skene's description, the origin,
and even the presence and function of these (para)urethral ducts
and glands, became the subject of considerable debate. This
contributed to a general
